The Efficacy and Safety of Regional Nerve Blocks in Total Knee Arthroplasty: Systematic Review and Direct Meta-Analysis |
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| Affiliation: | 1. Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania;2. Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri;3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota;4. Anderson Orthopaedic Research Institute, Alexandria, Virginia;5. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;6. Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, Indiana;7. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;8. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois;9. Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois;10. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois |
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| Abstract: | BackgroundRegional nerve blocks are widely used in primary total knee arthroplasty (TKA) to reduce postoperative pain and opioid consumption. The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after TKA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.MethodsWe searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published before March 24, 2020 on femoral nerve block, adductor canal block, and infiltration between Popliteal Artery and Capsule of Knee in primary TKA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks compared to a control, local peri-articular anesthetic infiltration (PAI), or between regional nerve blocks.ResultsCritical appraisal of 1,673 publications yielded 56 publications representing the best available evidence for analysis. Femoral nerve and adductor canal blocks are effective at reducing postoperative pain and opioid consumption, but femoral nerve blocks are associated with quadriceps weakness. Use of a continuous compared to single shot adductor canal block can improve postoperative analgesia. No difference was noted between an adductor canal block or PAI regarding postoperative pain and opioid consumption, but the combination of both may be more effective.ConclusionSingle shot adductor canal block or PAI should be used to reduce postoperative pain and opioid consumption following TKA. Use of a continuous adductor canal block or a combination of single shot adductor canal block and PAI may improve postoperative analgesia in patients with concern of poor postoperative pain control. |
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| Keywords: | total knee arthroplasty regional nerve block femoral nerve block adductor canal block infiltration between popliteal artery and capsule of knee |
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